Text: H.R.16 — 101st Congress (1989-1990)All Information (Except Text)

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HR 16 IH
101st CONGRESS
1st Session
 H. R. 16
To provide a program of national health insurance, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
January 3, 1989
Mr. DINGELL introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To provide a program of national health insurance, and for other purposes.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled, That this Act, with the following
  table of contents, may be cited as the `National Health Insurance Act'.
TABLE OF CONTENTS
Secs. 2-5. Declaration of purpose.
TITLE I--BENEFITS AND ELIGIBILITY
Sec.101.Classes of personal health services.
Sec.102.Availability of benefits.
Sec.103.How benefits obtained; free choice by patient.
Sec.104.Eligibility for benefits.
Sec.105.Provision of benefits for noninsured needy and other individuals.
TITLE II--PARTICIPATION OF PHYSICIANS, DENTISTS, NURSES, HOSPITALS, AND OTHERS
Sec.201.Physicians and dentists; specialists.
Sec.202.Nurses.
Sec.203.Hospitals.
Sec.204.Auxiliary services.
Sec.205.Agreements with individual practitioners, hospitals, and others.
Sec.206.Agreements with voluntary health insurance and other organizations.
Sec.207.Provisions common to all agreements.
Sec.208.Methods of payments for services.
Sec.209.Amount of payments for services.
Sec.210.Professional rights and responsibilities.
TITLE III--LOCAL ADMINISTRATION
Sec.301.Decentralization of administration.
Sec.302.Local administrative committee or officer.
Sec.303.Local area committees.
Sec.304.Local professional committees.
Sec.305.Methods of administration.
TITLE IV--STATE ADMINISTRATION
Sec.401.Declaration of policy.
Sec.402.State plan of operations.
Title V--National Health Insurance Board; National Advisory Medical Policy
Council; General Administrative Provisions
Sec.501.National Health Insurance Board.
Sec.502.Advisory Council.
Sec.503.Studies, recommendations, and reports.
Sec.504.Nondisclosure of information.
Sec.505.Prohibition against discrimination.
TITLE VI--ELIGIBILITY DETERMINATIONS, COMPLAINTS, HEARINGS, AND JUDICIAL REVIEW
Sec.601.Determinations as to eligibility for benefits.
Sec.602.Complaints of eligible individuals and of persons furnishing benefits.
TITLE VII--APPLICATION OF ACT TO INDIVIDUALS COVERED UNDER MEDICARE PROGRAM
Sec.701.Eligibility; benefits available.
Sec.702.Study and report.
TITLE VIII--FISCAL PROVISIONS
Sec.801.Personal health services account.
Sec.802.Allotment of funds.
Sec.803.Grants-in-aid for training and education.
TITLE IX--MISCELLANEOUS PROVISIONS
Sec.901.Definitions.
Sec.902.Effective date.
findings and declaration of purpose
  SEC. 2. (a) The Congress finds that--
  (1) the health of the Nation's people is the foundation of our Nation's
  strength, productivity, and wealth;
  (2) the assurance of adequate medical care to all of our people is essential
  to the general welfare and to the Nation's security;
  (3) since the tremendous advances in medical science in recent years have
  necessarily meant great advances in the cost of health services, our
  archaic system of paying for medical care--based on public and private
  charity for the poor, on unpredictable and often unbearable costs to
  the otherwise self-supporting, and on disproportionate charges for the
  well-to-do--has resulted in the following conditions:
  (A) the inability of the vast majority of our people to meet the shattering
  cost of serious or chronic illness;
  (B) the inability of most of our people to benefit from modern preventive
  medicine; and
  (C) wholly inadequate provision for the health needs of our farm families
  and agricultural workers;
  (4) the conditions described in the preceding paragraph cannot effectively
  be remedied under the present system of payment for medical care, or under
  any voluntary insurance system; and
  (5) a medical dole as an answer to this problem is repugnant to the American
  people and would certainly result in a system of state medicine, paid for
  from tax funds and rendered by regimented doctors.
  (b) The Congress declares the purposes of this Act to be to provide a sound
  economic foundation for our free system of medicine and to correct the
  maldistribution of health personnel and facilities by establishing a system
  of prepaid personal health insurance on the principle of social insurance.
  SEC. 3. In establishing a system of national health insurance, it is the
  policy of this Act that those persons and their dependents who are insured
  under the provisions of the Act shall pay for its benefits in proportion
  to their incomes, and shall, therefore, receive its benefits as a right
  and not as charity; that they shall be assured full freedom to choose
  their physicians and to change their choice as they may desire; that
  physicians and other professions furnishing services in accordance with
  the provisions of this Act shall be assured full freedom in the practice
  of their professions, including the right to accept or reject patients
  except as this right may be restricted by their own professional ethics
  or by the laws of the several States; and that the administration of this
  Act shall be based upon the American principle of decentralization.
  SEC. 4. In carrying out these policies, it is the intention of Congress
  that the major administrative responsibilities be placed in the hands of
  local bodies representing both those who pay for and receive services
  and those who render services, and operating within the framework of
  plans made by the several States, and approved by the Federal agency;
  that the Personal Health Services Account created by this Act shall be
  allotted equitably among the several States and by the States to their
  local areas; that voluntary as well as governmental organizations shall
  be recognized and utilized; and that all eligible individuals and their
  dependents as specified in this Act shall be entitled to its benefits
  without discrimination because of race, color, or creed.
  SEC. 5. The Congress further declares that it is the policy of the United
  States to take such steps and to utilize such of its resources as are
  necessary toward making adequate health services available to all our
  people regardless of residence, race, creed, color, or economic status.
TITLE I--BENEFITS AND ELIGIBILITY
classes of personal health services
  SEC. 101. (a) The personal health services to be made available as
  benefits to eligible individuals as provided in this title are medical
  services, dental services, podiatric services, home-nursing services,
  hospital services, and auxiliary services. Each class of services shall be
  provided by persons (including individuals, partnerships, corporations,
  associations, consumer cooperatives, and other organizations) who are
  authorized by applicable State law, and who are qualified under title II
  of this Act, to do so.
  (b) Medical services consist of (1) general medical services such as
  can be rendered by a physician engaged in the general or family practice
  of medicine, including preventive, diagnostic, and therapeutic care and
  periodic medical examinations; and (2) specialist services rendered by a
  physician who is a specialist in the class of services rendered, as defined
  in section 201 of this Act. Such services may be rendered at the office,
  home, hospital, or elsewhere, as necessary.
  (c) Dental services consist of (1) general dental services rendered by a
  dentist engaged in the general practice of dentistry, including preventive,
  diagnostic, and therapeutic care, and periodic dental examinations; and (2)
  specialist services rendered by a dentist who is a specialist in the class
  of services rendered, as defined in section 201 of this Act. Such services
  may be rendered at the office, home, hospital, or elsewhere, as necessary.
  (d) Podiatric services consist of those professional services of a podiatrist
  who is legally authorized to perform such services in the State in which
  he practices.
  (e) Home-nursing services consist of nursing care of the sick rendered in
  the home by a registered professional nurse or a qualified practical nurse.
  (f) Hospital services consist of hospitalization, including necessary nursing
  services, and such physician, laboratory, ambulance, and other services
  in connection with hospitalization as the National Health Insurance Board
  (hereinafter in this Act referred to as the `Board'), after consultation
  with the National Advisory Medical Policy Council (hereinafter in this
  Act referred to as the `Advisory Council'), by regulation designates
  as essential to good hospital care, for a maximum of sixty days in any
  benefit year; but hospital services shall not include hospitalization in
  a mental or nervous disease or tuberculosis hospital or institution, or
  hospitalization for any day more than thirty days following the diagnosis
  of tuberculosis or a psychosis. Whenever the Board, after consultation
  with the Advisory Council, finds that moneys in the account (established
  by section 701) are adequate and that facilities are available, it may by
  regulation increase the maximum days of hospitalization in any benefit year.
  (g) Auxiliary services consist of such chemical, bacteriological,
  pathological, diagnostic X-ray and related laboratory services; X-ray,
  radium, and related therapy; physiotherapy; services of optometrists;
  and prescribed drugs which are unusually expensive, special appliances,
  and eyeglasses; as the Board, after consultation with the Advisory Council,
  by regulation designates as auxiliary services on the basis of its finding
  that their provision under this Act is practicable and is essential to
  good health care.
availability of benefits
  SEC. 102. (a) Medical services, hospital services, and, except as otherwise
  provided in subsection (b) of this section, all other personal health
  services specified in section 101 shall be made available (subject to section
  701) as benefits to eligible individuals in all health-service areas within
  the United States as rapidly and as completely as possible having regard
  for the availability of the professional and technical personnel and the
  hospital and other facilities needed to provide such services. To this
  end the resources and needs of each State shall be surveyed and a program
  developed in each State to assure the maximum participation and use of health
  personnel and facilities in the provision of benefits, and to encourage
  improvement in the number and distribution of such personnel and facilities
  throughout the State. Additional surveys shall be undertaken as required,
  and the program in the State from time to time modified on the basis thereof.
  (b) If the Board, after consultation with the Advisory Council, finds that
  the personnel or facilities or funds that are or can be made available
  are inadequate to insure the provision of all services included as dental,
  home-nursing, or auxiliary services under section 101 of this Act, it may by
  regulation limit for a specified period the services which may be provided as
  benefits, or modify the extent to which, or the circumstances under which,
  they will be provided to eligible individuals. Any such restriction or
  limitation shall be reduced or withdrawn as rapidly as may be practicable;
  and, in the case of dental services, priority in the reduction or withdrawal
  of any such restriction or limitation shall be given to children.
  (c) The Board shall have the duty of studying and making recommendations as
  to needed services and facilities for the care of the chronic sick afflicted
  with physical ailments, and for the care of individuals afflicted with
  mental or nervous diseases, and as to needed provisions for the prevention
  of chronic physical diseases and of mental or nervous diseases; and of
  making reports from time to time, with recommendations as to legislation,
  but the first such report shall be made not later than two years after
  benefits under this Act first become available.
how benefits obtained: free choice by patient
  SEC. 103. Every individual eligible for personal health services available
  under this Act may freely select the physician, dentist, podiatrist,
  nurse, medical group, hospital, or other person of his choice to render
  such services, and may change such selection if the practitioner, medical
  group, hospital, or other person has agreed under title II of this
  Act to furnish the class of services required and consents to furnish
  such services to the individual. General medical, dental, and podiatric
  services may be obtained by request made by the individual directly to
  the practitioner of the individual's choice. Specialist, home-nursing,
  hospital, and auxiliary services shall be obtained from the specialist,
  nurse, hospital, or other person of the individual's choice, whenever
  the practitioner from whom he is receiving medical or dental services as
  benefits under this Act refers him for specialist, home-nursing, hospital,
  or auxiliary services upon determining that such services are required in
  the proper care of his particular case; or whenever, upon request of the
  individual, an administrative medical officer, upon a like determination,
  refers him for such services. The Board, by regulation, shall dispense with
  the necessity of referral in cases of emergency, and may dispense with the
  necessity of referral under specified circumstances or as respects specified
  classes of services, or both, if it finds, after consultation with the
  Advisory Council, that such action will be conducive to the provision of a
  more adequate amount and quality of health care and will not unreasonably
  increase the expenditures from the account for such services.
eligibility for benefits
  SEC. 104. (a) Subject to section 701, every individual shall be eligible
  for benefits under this Act throughout any benefit year if--
  (1) he has received (or, in the case of income from self-employment,
  has accrued)--
  (A) not less than $150 in wages during the first four of the last six
  calendar quarters preceding the beginning of the benefit year; or
  (B) not less than $50 in wages in each of six calendar quarters during the
  first twelve of the last fourteen calendar quarters preceding the beginning
  of the benefit year (not counting as one of such fourteen calendar quarters
  any quarter in any part of which the individual was under a total disability
  which continued for six months or more);
  (2) he is entitled, for the first month in the benefit year, to a benefit
  under title II of the Social Security Act or to an annuity under subchapter
  III (relating to civil service retirement) of chapter 83 of title 5,
  United States Code; or
  (3) he is on the first day of the benefit year a dependent of an individual
  who is eligible under paragraph (1) or paragraph (2).
  (b) Subject to section 701, every individual, not eligible therefor under
  subsection (a), shall be eligible for benefits under this Act during the
  remainder of a benefit year, beginning with--
  (1) the first day of any calendar quarter in such benefit year, if he has
  received (or, in the case of income from self-employment, has accrued)
  not less than $150 in wages during the first four of the last six calendar
  quarters preceding the beginning of such calendar quarter;
  (2) the first day of the first month in such benefit year for which he is
  entitled to a benefit or annuity referred to in subsection (a)(2); or
  (3) the first day in such benefit year on which he is or becomes a dependent
  of an individual who is eligible for benefits under subsection (a) (1) or
  (2) under paragraph (1) or (2) of this subsection.
  (c) No individual shall be deemed eligible for any personal health
  services as a benefit under this Act which are required by reason of any
  injury, disease, or disability on account of which any medical, dental,
  home-nursing, hospital, or auxiliary service is being received, or upon
  application therefor would be received, under a workmen's compensation
  law of the United States or of any State, unless equitable reimbursements
  to the account for the provision of such services as benefits have been
  made or assured under section 105 of this Act. In any case in which an
  individual receives any personal health service as a benefit under this
  Act with respect to any such injury, disease, or disability, for which
  no reimbursement to the account has been made or assured, the United
  States shall to the extent permitted by State law be subrogated to all
  rights of such individual, or of the person who furnished such service,
  to be paid or reimbursed, pursuant to such workmen's compensation law,
  for the cost of furnishing such service.
provision of benefits for noninsured needy and other individuals
  SEC. 105. (a) Subject to section 701, any or all benefits provided under this
  Act to individuals eligible for such benefits may be furnished to individuals
  (including the needy) not otherwise eligible therefor, for any period for
  which equitable reimbursements to the account on behalf of such needy or
  other individuals have been made, or for which reasonable assurance of such
  reimbursements have been given, by public agencies of the United States,
  the several States, or any of them or of their political subdivisions, such
  reimbursements to be in accordance with agreements and working arrangements
  negotiated with such public agencies. Services furnished to such needy or
  other individuals as benefits shall be of the same quality, be furnished
  by the same methods, and be paid for through the same arrangements, as
  services furnished to individuals eligible for benefits under this Act.
  (b) Federal grants to States under title XIX, and part A of title IV, of
  the Social Security Act, and Federal grants to States for aid or assistance
  under other provisions of such Act, shall be available to the States for
  provision of personal-health services for noninsured needy individuals in
  accordance with the provisions of subsection (a) of this section.
TITLE II--PARTICIPATION OF PHYSICIANS, DENTISTS, NURSES, HOSPITALS, AND OTHERS
physicians and dentists; specialists
  SEC. 201. Any individual who is a physician, dentist, or podiatrist legally
  authorized in a State to render any services included as general medical,
  dental, or podiatric services shall be deemed qualified to render such
  services in that State as benefits under this Act. Any such individual who
  is found to possess skill and experience of a degree and kind sufficient
  to meet standards established for a class of specialist services shall
  be deemed qualified to receive compensation for specialist services of
  such class as benefits under this Act. The Board, after consultation with
  the Advisory Council, shall establish standards as to the special skills
  and experience required to qualify an individual to render each such
  class of specialist services as benefits under this Act, and to receive
  compensation for such specialist services. In establishing such standards
  and in determining whether individuals qualify thereunder, standards and
  certifications developed by professional agencies shall be utilized as
  far as is consistent with the purposes of this Act, and regard shall be
  had for the varying needs and the available resources in professional
  personnel of the States and of local health-service areas.
nurses
  SEC. 202. Any individual shall be deemed qualified to render home-nursing
  services in a State as benefits under this title if such individual is (a)
  a professional nurse registered in such State, or (b) a practical nurse (1)
  who is qualified as such under State standards or requirements, or, in the
  absence of State standards or requirements, is found to be qualified under
  standards established by the Board after consultation with the Advisory
  Council and with nursing agencies, and (2) who furnishes nursing care under
  the direction or supervision of the State health agency, the health agency
  of a political subdivision of the State, or an organization supplying and
  supervising the services of registered professional nurses in the State.
hospitals
  SEC. 203. Any hospital or other institution shall be deemed qualified
  to furnish all or particular classes of hospital services as benefits
  under this Act if it is qualified to furnish such services under State
  standards or requirements for the maintenance and operation of hospitals
  which apply to the class or classes of services to be furnished, or if,
  in the absence of such State standards or requirements, it is found to
  afford professional services, personnel, and equipment adequate to promote
  the health and safety of individuals requiring the class or classes of
  hospital services to be furnished, according to standards which the Board
  shall establish after consultation with the Advisory Council.
auxiliary services
  SEC. 204. Any person (as defined in section 901(1)) who is qualified
  under State standards or requirements to furnish a class of services
  included as auxiliary services, or, in the absence of State standards or
  requirements, is found to be qualified to furnish a class of such services
  under standards established for such class by the Board after consultation
  with the Advisory Council, shall be deemed qualified to furnish such class
  of auxiliary services in that State as benefits under this Act.
agreements with individual practitioners, hospitals, and others
  SEC. 205. Any individual (or, in the case of hospital or auxiliary services,
  any person) qualified under this title to furnish any class or classes of
  personal health services as benefits may enter into an agreement with the
  State agency which in accordance with title IV has assumed responsibility for
  the administration in the State of benefits under this Act (hereinafter in
  this Act referred to as the `State agency'), to furnish such class or classes
  of services as benefits to individuals eligible therefor under this Act.
agreements with voluntary health insurance and other organizations
  SEC. 206. (a) In the provision of personal health services, it shall be the
  policy to utilize individuals or organizations qualified under this title
  to render such services, including (1) any organized group of individuals,
  (2) any partnership, association, or consumer cooperative, (3) any hospital
  or any hospital and its staff, or (4) any organization operating a voluntary
  health-service insurance plan or other voluntary health-service plan.
  (b) The State agency is authorized to enter into an agreement with any
  organization referred to in subsection (a) for the provision of personal
  health services under this Act. Any such organization, whether or not it
  enters into an agreement with the State agency on its own behalf, shall be
  permitted to act as agent for individuals or other persons in negotiating
  or in carrying out agreements with the State agency for rendering personal
  health services under this Act.
  (c) Any agreement under this section shall provide that each class of
  personal health services will be furnished only by individuals (or, in the
  case of hospital or auxiliary benefits, by persons, as defined in section
  901(1)) who are qualified under this title to render such class of services
  and each of whom has agreed or has authorized an agreement to be made on
  his behalf with the State agency that he will furnish such services in
  accordance with this Act and with regulations prescribed thereunder. Each
  such individual or person shall be responsible, both to the State agency
  and (in accordance with applicable State law) to individuals eligible for
  personal health services as benefits, for carrying out such agreement made
  by him or on his behalf.
provisions common to all agreements
  SEC. 207. (a) Each agreement made under this title shall specify the class
  or classes of services to be furnished or provided pursuant to its terms,
  shall contain an undertaking to comply with this Act and with regulations
  prescribed thereunder, shall be made upon terms and conditions consistent
  with the efficient and economical administration of this Act, and shall
  continue in force for such period and be terminable upon such notice as
  may be agreed upon.
  (b) No agreement under section 206, and no designation of an agent, shall
  for more than one year preclude any individual or person qualified to
  furnish personal health services from exercising such rights as he would
  otherwise have under this title (1) to negotiate and enter into an agreement
  directly with the State agency, or (2) to designate another agent for such
  negotiation, or (3) to participate in another agreement under section 206.
  (c) No agreement made under this title shall confer upon any individual or
  other person, or any group or other organization, the right of furnishing
  or providing personal health services as benefits, to the exclusion in
  whole or in part of other individuals, persons, groups, or organizations
  qualified to furnish or provide such services.
  (d) If the State agency after investigation finds that an individual or
  other person under agreement to furnish or provide personal health services
  as benefits is no longer qualified to furnish or provide such services,
  or has committed a substantial breach of the agreement, it shall notify
  such person of its findings, together with the reasons therefor, and in
  the absence of a request for a hearing by such person under title VI, or
  in the event of a final decision sustaining its findings after any hearing
  and further review provided under title VI, may terminate the agreement
  and withdraw the person's name from the list published pursuant to title
  III. After an agreement has been so terminated, no new agreement shall be
  entered into with such person under this Act unless and until such person
  gives reasonable assurances to the State agency of his or its ability and
  willingness to discharge all obligations and responsibilities under a new
  agreement satisfactorily in accordance with its provisions.
methods of payments for services
  SEC. 208. (a) Agreements for the furnishing of medical, dental, or podiatric
  services (other than specialist services) as benefits under this Act shall
  provide for payment--
  (1) on the basis of fees for services rendered as benefits, according to
  a fee schedule;
  (2) on a per capita basis, the amount being according to the number of
  individuals eligible for benefits who are on the practitioner's list;
  (3) on a salary basis, whole time or part time; or
  (4) on such combinations or modifications of these bases, including
  separate provision for travel and related expenses, as may be approved by
  the State agency;
according in each health-service area as the majority of the medical
practitioners or of the dental practitioners, respectively, under agreement to
furnish such services shall elect. Provision shall be made for another method
or methods of payment (from among the methods listed in this subsection)
to those medical practitioners or to those dental practitioners who do not
elect the method of such majority, when it is found that such alternative
method of making payments contributes to carrying out the provisions of
section 305 of this Act or otherwise promotes the efficient and economical
provision of medical or dental services in the area.
  (b) Agreements for the furnishing of specialist services as benefits
  under this Act may provide for payments on the basis of fee for service,
  per case, per session, per capita, on salary (whole time or part time),
  or other basis, or combination thereof.
  (c) Any of the methods of making payments from among the methods listed in
  subsection (a) or subsection (b) may be used in making payments to groups or
  practitioners or organizations or other agencies which undertake to provide
  specialist services as well as general medical or general dental services.
  (d) Agreements for the furnishing of hospital services as benefits under
  this Act shall provide for payment on the basis of the reasonable costs
  of hospitalization furnished as benefits. The Board, after consultation
  with the Advisory Council and with representatives of interested hospital
  organizations, may by regulation prescribe maximum rates for hospitalization
  furnished as benefits under this Act, and such maximum rates may be varied
  according to classes of localities or types of service. Payments to hospitals
  shall be based on the least expensive multiple-bed accommodations available
  in the hospital unless the patient's condition makes the use of private
  accommodations essential for his proper medical care. An agreement made
  for furnishing such services shall not affect the right of the hospital
  or other person with whom the agreement is made to require payments from
  patients with respect to the additional cost of more expensive facilities
  occupied at the request of the patient, or with respect to services not
  included as benefits under this Act.
  (e) Agreements for the furnishing of home-nursing services or auxiliary
  services as benefits under this Act shall provide for payment in accordance
  with such methods as the State agency may approve from among those set
  forth in regulations prescribed pursuant to this Act.
  (f) In any health-service area where agreements for the furnishing of general
  medical or general dental services provide for payment only on a per capita
  basis, the per capita payments with respect to those individuals residing
  in the area who have failed to select a practitioner or other person to
  furnish such services to them shall be made on a pro rata basis among the
  practitioners and other persons under agreement to furnish such services
  in the area.
amount of payments for services
  SEC. 209. (a) Rates or amounts of payment for particular services or classes
  of services furnished as benefits under this Act shall be adapted to take
  account of relevant regional, State, or local conditions and practices. In
  arriving at the payments to be made for services of general medical and
  dental practitioners, specialists, professional and practical nurses,
  or other practitioners, regard shall be had for the annual income or its
  equivalent which the payments will provide, and consideration shall be given
  to degree of specialization, and to the skill, experience, and responsibility
  involved in rendering the services. Such payments, together with the other
  terms and conditions of the agreements made under this title, shall be
  adequate to provide professional and financial incentives to practitioners
  to advance in their professions and to practice in localities where their
  services are most needed, to encourage high standards in the quality of
  services furnished, to give assistance in their use of opportunities for
  postgraduate study, and to allow for adequate vacation.
  (b) The rates and amounts of payments fixed under the different methods of
  payments specified in subsections (a), (b), (c), and (e) of section 208,
  and the methods of making payments, shall assure reasonably equivalent
  awards for practitioners selecting different methods of payment, in
  consideration of the value of the services they render.
  (c) Maximum limits upon the number of eligible individuals with respect
  to whom any person may undertake to render services in any local
  health-service area may be fixed by the local administrative committee
  or local administrative officer of that health-service area only on the
  basis of a recommendation of the professional committee in that area that
  such limitation is necessary to maintain high standards in the quality of
  medical, dental, or other services furnished as benefits. Any such limits
  shall take account of professional needs and practices and shall provide
  suitable exceptions for emergency and temporary situations.
  (d) The making of an agreement under section 206 with a group or other
  organization shall not operate to increase the payments to be made pursuant
  to any such agreement over the amounts which, in the absence of such
  group or organization would be payable for the same services pursuant to
  agreements made under section 205 directly with the person or persons who
  furnish the services.
professional rights and responsibilities
  SEC. 210. (a) Any person who enters into an agreement under this title
  may terminate such agreement after reasonable notice and after suitable
  arrangements are made to fulfill professional obligations to eligible
  individuals.
  (b) Every physician, dentist, or nurse agreeing to render services as
  benefits under this Act shall be free to practice his profession in the
  locality of his own choosing, consistent with the requirements of the laws
  of the States.
  (c) Every physician, dentist, nurse, hospital, or other person entering
  into an agreement under this title shall be free to the extent consistent
  with applicable State law and customary professional ethics to accept or
  reject as a patient any individual requesting his services.
  (d) No supervision or control over the details of administration or
  operation, or over the selection, tenure, or compensation of personnel,
  shall be exercised under the authority of this Act over any hospital which
  has agreed to furnish personal health services as benefits.
TITLE III--LOCAL ADMINISTRATION
decentralization of administration
  SEC. 301. In order that personal health-service benefits may be made
  available promptly and in a manner best adapted to local practices,
  conditions, and needs, responsibility for administration of the benefits
  provided under this Act in the several local health-service areas shall be
  decentralized as fully as practicable to local administrative committees
  or local administrative officers, acting with the advice and assistance,
  as provided in this title, of local professional committees and, in the
  case of local administrative officers, the advice and assistance of local
  area committees. The health-service areas of a State shall be those so
  designated in the State plan of operations.
local administrative committee or officer
  SEC. 302. The local administrative agency for each local health-service
  area may, as determined by the State, be either--
  (1) a local administrative committee established in accordance with section
  303, which shall act through a local executive officer; or
  (2) a local administrative officer, who shall act with the advice and
  assistance of a local advisory committee established in accordance with
  section 303.
The local administrative committee or officer, with the advice and assistance
of such local professional committees as may from time to time be established,
shall arrange for the furnishing of personal health-service benefits to
eligible individuals in the area and to that end shall--
  (a) publish, and make readily available to eligible individuals in the area,
  lists of the names of all persons who have agreed to furnish personal health
  services in the area, together with the class or classes of services which
  each has undertaken to furnish;
  (b) disseminate pertinent information concerning the rights and privileges
  under this Act of eligible individuals and of persons qualified to furnish
  personal health services as benefits;
  (c) maintain effective relationships with physicians, dentists, nurses,
  hospitals, and other persons who have entered into agreements to furnish
  personal health services in the area, in order to facilitate the furnishing
  of such services in accordance with such agreements, to assure full and
  prompt payment to such persons for services so furnished, and to enlist
  their full cooperation in the administration of benefits under this Act
  in the area;
  (d) receive and, to the extent possible in the local area, adjust any
  complaints which may be made concerning the administration of benefits
  under this Act in the area;
  (e) perform such other duties (including the making of payments to persons
  furnishing personal health services in the area) as may be assigned by
  the State agency; and
  (f) take or initiate such other administrative action as he finds will
  best carry out, within the area, the provisions of this Act, and best
  effectuate its purposes.
local area committees
  SEC. 303. (a) A local area committee shall be established in each
  health-service area. If designated by the State as a local administrative
  committee, the local area committee shall perform the functions specified
  in section 302 and shall formulate policies for the administration of
  benefits under this Act in the area. If designated as an advisory committee,
  it shall advise and assist in the performance of such functions and the
  formulation of such policies. The committee, whether administrative or
  advisory, shall participate in the solution of problems affecting the
  administration of such benefits, shall promote impartiality and freedom
  from political influence in such administration, and shall perform related
  functions to the end that administration in the area may be responsive to
  the wishes and needs of persons furnishing and receiving benefits in the
  area, be adapted to local practices and resources, and provide adequate
  and high quality personal health services to all eligible individuals.
  (b) Each local area committee shall consist of not less than eight nor more
  than sixteen members. The members shall be so selected that a majority of
  the committee shall be representative of the interests of individuals in
  the area who are eligible for benefits, and the remaining members shall
  be chosen from the several professions, hospitals, and other organizations
  in the area by whom such benefits will be provided.
  (c) The local area committee shall meet as often as may be necessary, and
  whenever one-third or more of the members request a meeting; in the case of
  a local administrative committee, not less frequently than once each month,
  and in the case of a local advisory committee, not less frequently than
  once in each quarter of the year. At least one meeting of the committee
  each year shall be open to the public, notice of which shall be published
  and at which any person in the area may participate. At least once each
  year there shall be a statewide meeting of local administrative officers
  and representatives of local administrative committees. At least once in
  each year there shall be a statewide meeting of representatives of all
  local advisory committees in the State, and any reports or recommendations
  made at such meeting shall on the request of such meeting be transmitted
  through the State agency to the Board.
local professional committees
  SEC. 304. Local committees representative of the persons furnishing personal
  health services in the area shall be established in each health-service area
  to assist the local administrative committee and its executive officer, or
  the local administrative officer and the local advisory committee, as the
  case may be, in the preservation of the customary freedom and responsibility
  (under applicable State law) of practitioners in the exercise of professional
  judgment as to the care of patients, and in the solution of technical
  problems concerning the participation of professional personnel, hospitals,
  and other qualified persons in the provision of personal health services
  as benefits, and to advise the local administrative or executive officer
  and the local area committee regarding matters of professional practice or
  conduct arising in connection with the performance of agreements for the
  provision of such services. Such local committees shall meet on call of
  the local administrative committee or officer, as the case may be, or upon
  their own motion. The members of any such local professional committee may
  be professional members of the local area committee or other professional
  persons or both.
methods of administration
  SEC. 305. (a) In each health-service area the methods of administration
  shall be such as to--
  (1) insure the prompt and efficient care of individuals entitled to personal
  health services as benefits;
  (2) promote personal relationships between physician and patients;
  (3) promote coordination among and between general practitioners,
  specialists, those who furnish auxiliary services, nurses, and hospitals,
  in the furnishing of services under this Act, between them and public-health
  centers and agencies, and educational service, research, and other related
  agencies or institutions, and between preventive, diagnostic, and curative
  services, public and private;
  (4) aid in the prevention of disease, disability, and premature death;
  (5) encourage improvement in the number and distribution of professional
  personnel and facilities; and
  (6) insure the provision of adequate service with the greatest economy
  consistent with high standards of quality.
  (b) Local administrative officers shall be appointed by the State agency
  or the head thereof, in accordance with the merit system provided for in
  the State plan of operations; local administrative committees shall be
  appointed by such agency or the head thereof, from individuals residing
  in the respective health-service areas, and the executive officers
  of such committees shall be appointed by the committees in accordance
  with the merit system; the local health-service areas shall be those so
  designated in such plan; and members of local advisory committees and of
  local professional committees shall be selected in accordance with methods
  set forth in such plan.
  (c) In exercising their functions and discharging their responsibilities
  under this Act, local administrative officers and communities, local
  advisory committees, and local professional committees shall observe the
  provisions of this Act, and of regulations prescribed thereunder, and of
  any regulations, standards, and procedures prescribed by the State agency.
TITLE IV--STATE ADMINISTRATION
declaration of policy
  SEC. 401. It is the intent of Congress that the benefits provided under
  this Act be administered wherever possible by the several States, in
  accordance with plans of operations submitted and approved as provided in
  this title, and in each State insofar as feasible by the same State agency
  which administers, or supervises the administration of, the State's general
  public health and maternal and child health programs.
state plan of operations
  SEC. 402. (a) Any State desiring to assume responsibility for the
  administration in the State of the personal health-service benefits provided
  under this Act to all individuals in the State who are eligible for such
  benefits, may do so for the period beginning October 1, 1990 (when benefits
  first become available under this Act), or for the period beginning October
  1 of any succeeding year, if it has undertaken, through its legislature,
  to administer such benefits in accordance with the provisions of this Act
  and with the provisions of regulations and standards prescribed thereunder,
  and, at least twelve months in advance, has submitted and had approved a
  State plan of operations which--
  (1) designates as the sole agency for the statewide administration of
  benefits under this Act a single State agency duly authorized under the
  law of the State to administer such benefits within the State in accordance
  with the provisions of this Act, the provisions of regulations and standards
  prescribed thereunder, and the provisions of the State plan;
  (2) provides for the designation of a State advisory committee which shall
  include members who are familiar with the needs for personal health services
  in urban and rural areas, and who are representative of the interests of
  individuals in the State who are eligible for benefits, such members to
  constitute a majority, and members chosen from the several professions,
  hospitals, and other organizations in the State by whom such benefits will
  be provided, to advise the State agency in carrying out the administration
  of such benefits in the State;
  (3) provides for the decentralized administration of this Act in the State
  in accordance with title III for the designation of local health-service
  areas, and for such methods of selecting the members of local advisory
  committees and of local professional committees as are calculated to insure
  representation of the nature set forth in sections 303 and 304, respectively;
  (4) provides such methods of administration, including methods relating to
  the establishment and maintenance of personnel standards on a merit basis
  (except that the Board shall exercise no authority with respect to the
  selection, tenure of office, or compensation of any individual employed in
  accordance with such methods), as are found by the Board to be necessary
  for the proper and efficient administration of such benefits in the State;
  (5) provides for the making of surveys of the resources and needs of the
  State, in accordance with section 102(a), and sets forth a program for the
  administration of such benefits in the State which gives reasonable assurance
  (A) that maximum use will be made of all available health personnel and
  facilities desiring to participate in the provision of benefits to eligible
  individuals, (B) that funds allotted to the State for the several classes of
  benefits will be allocated in such manner as to give reasonable assurance of
  the availability of services in all health-service areas in the State, and
  (C) that any maldistribution or other inadequacies in the health personnel
  or facilities available for such purpose, or in the quality of the services
  rendered, will be progressively improved as rapidly as may be practicable;
  (6) provides that the State agency will make such reports in such form and
  containing such information as the Board may from time to time reasonably
  require, and give the Board, upon demand, access to the records upon which
  such information is based;
  (7) provides that all Federal funds paid to the State agency for purposes
  of carrying out this Act in the State shall be properly safeguarded and
  expended solely for the purposes for which paid, and provides for the
  repayment by the State to the United States of any such funds lost by the
  State agency or diverted from the purposes for which paid; and
  (8) provides for cooperation, including where necessary entering into
  working agreements (with any appropriate transfer of funds), with other
  public agencies of the State or of its political subdivisions concerned
  with programs related to the purposes of this Act, and with appropriate
  agencies of other States or of the United States administering this Act,
  or benefits under this Act, in other States.
  (b) The Board shall approve any State plan and any modification thereof
  submitted by the State which it finds complies with the provisions of
  subsection (a). No change in a State plan shall be required within one
  year after initial approval thereof, or within one year after any change
  thereafter required therein, by reason of any change in the regulations
  or standards prescribed pursuant to this Act, except with the consent of
  the State or in accordance with further action by Congress.
  (c) In the event of its disapproval of any plan or any modification therein
  submitted by a State pursuant to this title, the Board shall notify the
  State of such disapproval and shall, upon request of the State, afford it
  reasonable notice and opportunity for a hearing on such disapproval.
  (d) If a State has not prior to October 1, 1990, submitted and had approved
  a plan of operations, the Board shall notify the Governor of the State
  that the Board will be required to administer this Act in the State,
  commencing October 1, 1990. The Board shall provide for the publication
  of such notice in at least two newspapers of general circulation in the
  State. If within sixty days after such notification to the Governor the
  State has not submitted an approvable plan, the Board shall continue such
  administration until one year after the submission and approval of a plan
  of operations in accordance with this section. The Board may waive the
  requirement that a State plan must be submitted and approved one year
  prior to commencement of State administration if it is satisfied in a
  particular case that the substitution of a shorter preparatory period will
  not prejudice the interests of eligible individuals in the State.
  (e) Whenever the Board, after reasonable notice and opportunity for hearing
  to the State, finds that the State, having submitted and had approved a
  plan of operations under this title--
  (1) is not complying substantially with the provisions of such plan, or
  with the provisions of this Act or any regulations or standards prescribed
  thereunder, or
  (2) has withdrawn its plan or failed to change it when and as required by
  a change in this Act or in regulations prescribed thereunder,
the Board shall notify the Governor of the State of such findings, together
with its reasons therefor and a statement concerning the effect of such
findings under this Act, and shall provide for the publication of such notice
in at least two newspapers of general circulation in the State. If within
sixty days following such a notice the State has not taken appropriate action
to bring its plan or its administration thereof into conformity with this
Act and regulations and standards thereunder, the Board shall immediately
assume responsibility for the administration of this Act in the State and
shall administer the same in such State for so long thereafter as the State
fails to give reasonable assurances of substantial compliance or fails to
submit an approvable plan, as the case may be.
  (f) In any State in which the Board has assumed responsibility for the
  administration of benefits under this Act as provided in subsections (d)
  and (e) of this section, the Board shall have and discharge all authority
  and duties, in accordance with the provisions of this Act, which it finds
  necessary for that purpose, and the term `State agency' wherever used in
  title II or title III of this Act shall be deemed to refer to the Board.
  (g) Nothing in this Act shall preclude any State or any political
  subdivision thereof, whether or not the State has assumed responsibility
  for the administration of benefits under this Act, from furnishing, with
  funds available from sources other than the account, any additional health
  services to individuals who are eligible for benefits under this Act or
  any or all health services to individuals who are not so eligible.
TITLE V--NATIONAL HEALTH INSURANCE BOARD; NATIONAL ADVISORY MEDICAL POLICY
COUNCIL; GENERAL ADMINISTRATIVE PROVISIONS
national health insurance board
  SEC. 501. (a) There is hereby established in the Department of Health and
  Human Services a National Health Insurance Board, to be composed of five
  members, three of whom shall be appointed by the President by and with
  the advice and consent of the Senate, and the other two of whom shall be
  the Surgeon General of the Public Health Service and the Commissioner of
  Social Security. During his term of membership on the Board, no appointed
  member shall engage in any other business, vocation, or employment. At
  least one of the appointed members shall be a doctor of medicine licensed
  to practice medicine or surgery in one of the States. Each appointed
  member shall receive a salary at an annual rate of basic pay, established
  by the President, which is not less than the annual rate of basic pay for
  positions at level V of the Executive Schedule and which is not greater than
  the annual rate of basic pay for positions at level IV of the Executive
  Schedule, and shall hold office for a term of six years, except that (1)
  any member appointed to fill a vacancy occurring prior to the expiration of
  the term for which his predecessor was appointed shall be appointed for the
  remainder of such term; and (2) the terms of office of the members first
  taking office after the date of the enactment of this Act shall expire, as
  designated by the President at the time of appointment, one at the end of
  two years, one at the end of four years, and one at the end of six years,
  after the date of the enactment of this Act. The President shall designate
  one of the appointed members as the Chairman of the Board.
  (b) All functions of the Board shall be administered by the Board under the
  direction and supervision of the Secretary of Health and Human Services. The
  board shall perform such functions as it finds necessary to carry out
  the provisions of this Act, and shall make all regulations and standards
  specifically authorized to be made in this Act and such other regulations
  not inconsistent with this Act as may be necessary. The Board may delegate
  to any of its members, officers, or employees, or with the approval of the
  Secretary to any other officer or employee of the Department of Health
  and Human Services, such of its powers or duties, except that of making
  regulations, as it may consider necessary and proper to carry out the
  provisions of this Act. The Board may also enter into agreements for the
  furnishing or provision of personal health services under this Act without
  regard to the provisions of title 5, United States Code, pertaining to the
  appointment, status, or compensation of Federal employees, or pertaining
  to contracts for personal services, and without regard to section 3709
  of the Revised Statutes (41 U.S.C. 5), and any person rendering services
  pursuant to an agreement so made shall not by reason thereof be deemed to
  be an employee of the United States.
  (c) In administering the provisions of this Act, the Board is authorized to
  utilize the services and facilities of any executive department or other
  agency of the United States in accordance with an agreement with the head
  thereof. Payment for such services and facilities shall be made in advance
  or by way of reimbursement, as may be agreed upon with the head of the
  executive department or other agency furnishing them.
  (d) Personnel of the Board shall be appointed by the Secretary upon
  recommendation of the Board. The Secretary is authorized to detail to
  the Board, upon its request, any officer or employee of the Department of
  Health and Human Services, and in his discretion to reimburse, from funds
  available for the administration of this Act, the appropriation from which
  the salary or, in the case of commissioned officers of the Public Health
  Service, the pay and allowances of such officer or employee are paid.
  (e) Upon the request of any State agency administering a State plan of
  operations pursuant to title IV of this Act, or upon the request of any
  State desiring to prepare and submit a plan of operations, any officer
  or employee of the Board (including any officer or employee detailed to
  the Board pursuant to subsection (d)) may be detailed by the Board to
  assist in the administration, or in the preparation, of such State plan of
  operations. The funds available for the Federal administration of this Act
  may, in the discretion of the Secretary, be reimbursed from funds allotted
  to the State pursuant to section 802 and available for State administration,
  for the salary (or for the pay and allowances) of any officer or employee
  so detailed.
advisory council
  SEC. 502. (a) There is hereby established a National Advisory Medical
  Policy Council to consist of the Chairman of the Board, who shall serve as
  Chairman of the Advisory Council ex officio, and sixteen members appointed
  by the Secretary of Health and Human Services. At least eight of the sixteen
  appointed members shall be individuals who are familiar with the need for
  personal health services in urban or rural areas and who are representative
  of the interests of individuals eligible for benefits under this Act, and
  at least six of the members shall be individuals who are outstanding in
  the medical or other professions concerned with the provision of services
  provided as benefits under this Act and who are representative of the
  individuals, organizations, and other persons by whom personal health
  services will be provided. Each appointed member shall hold office for
  a term of four years, except that any member appointed to fill a vacancy
  occurring prior to the expiration of the term for which his predecessor
  was appointed shall be appointed for the remainder of that term, and the
  terms of the members first taking office shall expire, as designated by the
  Secretary at the time of appointment, four at the end of the first year,
  four at the end of the second year, four at the end of the third year,
  and four at the end of the fourth year after the date of appointment. The
  Advisory Council is authorized to appoint such special advisory technical
  or professional committees as may be useful in carrying out its functions,
  and the members of such committees may be members of the Advisory Council,
  or other persons, or both. Appointed Advisory Council members and members
  of technical or professional committees, while serving on business of the
  Council (inclusive of traveltime), shall receive compensation at rates fixed
  by the Secretary, but not exceeding $200 per day, and shall be entitled
  to receive actual and necessary traveling expenses and per diem in lieu
  of subsistence while so serving away from their places of residence. The
  Advisory Council, its appointed members, and its committees, shall be
  provided with such secretarial, clerical, or other assistance as may be
  provided by the Congress for carrying out their respective functions. The
  Advisory Council shall meet as frequently as the Board deems necessary,
  but not less than twice each year. Upon request by six or more members,
  it shall be the duty of the Chairman to call a meeting of the Council.
  (b) The Advisory Council shall advise the Board with reference to matters of
  general policy and administration arising in connection with the making
  of regulations, the establishment of professional standards, and the
  performance of its other duties under this Act.
  (c) Section 14 of the Federal Advisory Committee Act shall not apply to
  the Advisory Council.
studies, recommendations, and reports
  SEC. 503. The Board shall have the duty of studying and making
  recommendations as to the most effective methods of providing health
  services, and as to legislation and matters of administrative policy
  concerning health and related subjects. At the beginning of each regular
  session of Congress, it shall make a full report to Congress of the
  administration of this Act, including a report with regard to the adequacy
  of its financial provisions contained in this Act and of appropriations
  made pursuant thereto, the methods of allotment of funds among the States,
  and related matters. Such report shall include a record of consultations
  with the Advisory Council, recommendations of the Advisory Council, and
  comments thereon.
nondisclosure of information
  SEC. 504. Information concerning an individual, obtained from him or
  from any physician, dentist, nurse, or hospital, or from any other person
  pursuant to or as a result of the administration of this Act, shall be held
  confidential (except for statistical purposes) and shall not be disclosed
  or be open to public inspection in any manner revealing the identity of the
  individual or other person from whom the information was obtained or to
  whom the information pertains, except as may be necessary for the proper
  administration of this Act or of other laws, State or Federal. Any person
  who shall violate any provision of this section shall be deemed guilty of
  a misdemeanor and, upon conviction thereof, shall be punished by a fine
  not exceeding $10,000 or by imprisonment not exceeding one year, or both.
prohibition against discrimination
  SEC. 505. In carrying out the provisions of this Act there shall be no
  discrimination on account of race, creed, or color. Personal health services
  shall be made available as benefits to all eligible individuals, and all
  persons qualified under title II to enter into agreements to furnish or
  provide such services shall be permitted to do so.
TITLE VI--ELIGIBILITY DETERMINATIONS, COMPLAINTS, HEARINGS, AND JUDICIAL REVIEW
determinations as to eligibility for benefits
  SEC. 601. (a) The Secretary of Health and Human Services through such
  units of the Department of Health and Human Services as he may determine,
  shall upon his own initiative or upon application of any individual make
  determinations as to the eligibility of individuals for benefits under this
  Act. Whenever requested by any individual determined by the Secretary not
  to be eligible for benefits for any period, or by a dependent of any such
  individual, the Secretary shall give such individual or such dependent
  reasonable notice and opportunity for a hearing with respect to such
  determination and on the basis of the evidence adduced at the hearing
  shall affirm, modify, or reverse his determination.
  (b) In carrying out his responsibility under this section, the Secretary
  shall have all the powers and duties conferred upon him under sections 205
  and 206 of the Social Security Act. Such powers and duties shall be subject
  to the same limitations and rights of judicial review as are contained in
  section 205 of such Act. Eligibility for benefits under this title based on
  entitlement to an annuity under subchapter III (relating to civil service
  retirement) of chapter 83 of title 5, United States Code, shall be determined
  on the basis of certification by the Office of Personnel Management.
  (c) Nothing in title IV of this Act shall be deemed to require or authorize
  any assumption by the State agency, designated in accordance with an
  approved State plan of operations approved under such title, of any of
  the Secretary's responsibilities under this section, but the Secretary may
  utilize existing facilities and services of any such agency on the basis
  of mutual agreements with such agency.
complaints of eligible individuals and of persons furnishing benefits
  SEC. 602. (a) Any eligible individual aggrieved by reason of his failure to
  receive any personal health-service benefits to which he believes himself
  entitled, or dissatisfied with any service rendered him as a personal
  health-service benefit, and any person who has entered into an agreement to
  furnish services as personal health-service benefits and who is aggrieved by
  the failure or alleged failure of a local or other administrative officer or
  a local administrative committee to carry out the agreement in accordance
  with its terms, may make a complaint to the local administrative officer
  or local executive officer in the area in which the action or inaction
  complained of occurred, or to such other officer as may be provided in
  regulations. If the officer to whom such complaint is made finds, after
  investigation, that the complaint is well founded, he shall promptly take
  such steps as may be necessary and appropriate to correct the action or
  inaction complained of; and he shall notify the individual or other person
  making the complaint of his disposition thereof. Any such individual or
  other person dissatisfied with the action taken may in writing request a
  hearing thereon and shall be afforded opportunity for the same pursuant
  to subsection (b) of this section.
  (b) Provision shall be made for the establishment of necessary and sufficient
  impartial tribunals to afford hearings to individuals and other persons
  entitled thereto under subsection (a) of this section, or section 207(d)
  of this Act, and for further review of the findings, conclusions, and
  recommendations of such tribunals, in accordance with regulations made
  by the Board, after consultation with the Advisory Council. With respect
  to any complaint involving matters or questions of professional practice
  or conduct, the hearing body shall contain competent and disinterested
  professional representation; and with respect to any complaint involving
  only matters or questions of professional practice or conduct the hearing
  body shall consist exclusively of such professional persons.
  (c) In administering this section in any State which has not assumed
  responsibility for the administration of benefits under this Act as provided
  in title IV, the Board (subject to the provisions of section 501(b))
  shall, insofar as they are applicable to its functions under this Act,
  have all the powers and duties conferred upon the Secretary by sections
  205 and 206 of the Social Security Act. Such powers and duties shall be
  subject to the limitations and rights of judicial review contained in
  section 205 of such Act.
  (d) In any State which has assumed responsibility for the administration
  of benefits under this Act as provided in title IV the powers and duties of
  the State agency shall be subject to such rights of judicial review in the
  courts of the State as the law of the State may provide; subject, however,
  to review by the Supreme Court of the United States in such cases and in such
  manner as is provided in section 1257 of title 28 of the United States Code.
TITLE VII--APPLICATION OF ACT TO INDIVIDUALS COVERED UNDER MEDICARE PROGRAM
eligibility; benefits available
  SEC. 701. (a) In the case of any individual who is entitled to hospital
  insurance benefits under part A of title XVIII of the Social Security Act,
  or to supplementary medical insurance benefits under the insurance program
  established by part B of such title, during any benefit year or part thereof
  in which he is otherwise eligible for benefits under this Act in accordance
  with section 104 or would otherwise be furnished such benefits in accordance
  with section 105, the personal health services (specified in section 101)
  which may be made available to him as benefits under this Act shall be
  limited to those services (otherwise available to him in accordance with
  section 102) for which he is ineligible under part A or B of such title
  XVIII. For purposes of the preceding sentence, an individual shall be
  considered ineligible under part A or B of such title XVIII if no payment
  is or can be made to him or on his behalf thereunder with respect to the
  item or service involved, whether because he is not entitled to benefits
  under whichever such part is applicable, because no payment is provided
  under either such part for the item or service involved, or because he
  has exhausted his entitlement to have payment made thereunder for items
  or services of the type involved; and shall also be considered ineligible
  under part A or B of such title XVIII with respect to any item or service
  (for which he is otherwise entitled to have payment made thereunder) to
  the extent that payment is not made with respect to such item or service
  because of the application of the deductible and coinsurance provisions
  of sections 1813 and 1833 of the Social Security Act.
  (b) The Board, after consultation with the Advisory Council, shall prescribe
  such regulations as may be necessary or appropriate to insure, in the case
  of individuals whose benefits under this Act are limited under subsection
  (a), that the combination of benefits under this Act and title XVIII of
  the Social Security Act will effectively carry out (without duplication
  of benefits) the purpose of this Act.
  (c) The limitation under subsection (a) of an individual's benefits
  under this Act shall not be construed as affecting the eligibility of his
  dependents for such benefits in accordance with subsection (a)(3) or (b)(3)
  of section 104.
study and report
  SEC. 702. As soon as practicable after the enactment of this Act the
  Secretary of Health and Human Services shall undertake and carry out a
  full and complete study of the interrelationship of the program of national
  health insurance under this Act and the program of health insurance for the
  aged under title XVIII of the Social Security Act, in order to determine
  the way in which the latter program may be most effectively and equitably
  transferred to and incorporated in the program under this Act. In conducting
  such study, the Secretary shall give particular attention to the transitional
  problems which would result from such a transfer, and shall consider in
  detail (with respect to each such program) the benefits provided, the
  standards of eligibility therefor, the standards and qualifications for
  participation by providers of services of various types, the methods of
  administration, the costs and methods of financing, and any other matters
  which might assist in making such determination and in insuring that all
  desirable features of the program under title XVIII of the Social Security
  Act will to the maximum extent feasible be preserved with respect to the
  individuals covered by that program (and, in appropriate cases, included in
  the program under this Act for all individuals who are eligible thereunder,
  without regard to any transfer). The Secretary shall submit to the President
  and the Congress, no later than one year after the date of the enactment
  of this Act, a complete report of the study conducted under this section
  together with his findings as to the most effective and equitable way in
  which the transfer under consideration could be effected and his detailed
  recommendations for legislative, administrative, and other actions to
  accomplish it.
TITLE VIII--FISCAL PROVISIONS
personal health services account
  SEC. 801. (a) There is hereby created on the books of the Treasury of the
  United States a separate account to be known as the `Personal Health Services
  Account' (hereinafter in this Act referred to as the `account'). Funds
  in the account not required for current withdrawals shall be invested by
  the Secretary of the Treasury in the types of obligations which may be
  acquired, under section 201 of the Social Security Act, by the Federal
  Old-Age and Survivors Insurance Trust Fund and the Federal Disability
  Insurance Trust Fund. Funds in the account shall be available for all
  expenditures necessary or appropriate to carry out this Act; except that
  (subject to the provisions of section 802(g)) only so much of such funds
  shall be available for salaries or other administrative expenses of any
  department or agency of the United States as may be authorized in annual
  or other appropriation Acts.
  (b) There shall be appropriated to the account for the fiscal year 1990,
  and for each fiscal year thereafter--
  (1) sums equal to 3 percent of all wages estimated to be received during
  such fiscal year;
  (2) sums equal to the estimated cost of furnishing dental services and
  home-nursing services as personal health-service benefits during such
  fiscal year; and
  (3) any further sums required to meet expenditures to carry out this Act.
  (c) There shall be appropriated to the account in the fiscal year 1990,
  a sum equal to 1 percent of all wages estimated to be received during such
  fiscal year, to constitute on October 1, 1990, a reserve in the account
  for the purposes specified in section 802(a).
  (d) The aggregate appropriations to the account, pursuant to clauses
  (2) and (3) of subsection (b), in appropriation Acts for any fiscal year
  ending in 1990, 1991, or, 1992, shall not exceed one-half of 1 percent,
  and in appropriation Acts for any fiscal year ending in 1993, 1994,
  or, 1995 shall not exceed 1 percent, of the estimated annual average of
  all wages received during the three fiscal years preceding such fiscal
  year. Whenever an appropriation is made on the basis of an estimate of wages
  to be received during a fiscal year, the appropriations for subsequent
  fiscal years shall be adjusted by any amount by which such estimate was
  greater or less than the amount of wages actually received. Before January
  1, 1995, and periodically thereafter, the Congress will review this Act
  and will determine the amounts of appropriations to be made thereafter.
  (e) Sums received as reimbursements to the account pursuant to section 104(c)
  or section 105, or by virtue of subrogation pursuant to section 104(c),
  shall be deposited in the account and shall be available in accordance
  with the provisions of subsection (a) of this section.
allotment of funds
  SEC. 802. (a) The Board, after consultation with the Advisory Council, shall
  determine, as far in advance of the beginning of each fiscal year as is
  possible, the sums which shall be available from the account for provision
  during the fiscal year of all classes, and of each of the five classes,
  of personal health-service benefits specified in section 101(a). Such
  sums shall be determined, after taking into consideration the estimated
  amount which will be in the account at the beginning of the fiscal year
  and the anticipated income of the account thereafter, with a view (1)
  to maintaining as nearly as practicable a uniform rate of expenditure for
  personal health-service benefits in successive fiscal years, except for
  appropriated allowance on account of anticipated increase in the personnel
  and facilities available to furnish personal health-service benefits and on
  account of reduction or withdrawal of restrictions or limitations pursuant
  to section 102(b), and (2) to establishing and maintaining a reserve in the
  account adequate to meet emergency demands in accordance with subsection
  (d) of this section and adequate to maintain the rate of expenditure or
  to permit its gradual reduction if the income of the account should fall
  below the income which had been anticipated.
  (b) In accordance with regulations prescribed after consultation with the
  State agencies, the Board, prior to the beginning of each fiscal year shall
  allot to the several States, for the fiscal years 1990, 1991, and 1992,
  90 percent, and for each fiscal year thereafter 95 percent of each sum
  determined pursuant to subsection (a). Such regulations shall provide for
  allotments on the basis of--
  (1) the population in the several States eligible for benefits under
  this Act;
  (2) professional and other personnel, hospitals, and other facilities,
  and supplies and commodities, to be available in the several States in
  the provision of such benefits; and
  (3) the cost of reasonable and equitable compensation to such personnel
  and facilities and for such supplies and commodities.
Such allotments shall operate, to the maximum extent possible, both to assure
provision to eligible individuals of adequate personal health-service benefits
in all States and all local health-service areas, and also to increase the
adequacy of services where personnel and facilities are below the national
average.
  (c) From time to time during each fiscal year, the Board shall allot to
  the several States the remaining 10 percent or the remaining 5 percent,
  as the case may be, of each sum determined pursuant to subsection
  (a). In making allotments under this subsection, the Board shall take
  into consideration the factors specified in subsection (b), but shall,
  in addition, give special consideration to the extent of which allotments
  under subsection (b) have proved to be insufficient to permit provision
  of reasonably adequate benefits under this Act.
  (d) In addition to the sums determined pursuant to subsection (a) to be
  available for the provision of personal health-service benefits, the
  Board, after consultation with the Advisory Council, is authorized to
  make emergency allotments from the account if it finds that a disaster,
  epidemic, or other cause has substantially increased the volume of personal
  health-service benefits required in any part of the United States over the
  volume anticipated when the determinations pursuant to subsection (a) were
  made. Allotments pursuant to this subsection shall be made to such State
  or States, for such class or classes of personal health-service benefits,
  and in such amounts, as the Board may find necessary to meet the emergency.
  (e) The Board shall from time to time determine the amounts to be paid
  to each State from its allotments under this section, and shall certify
  to the Secretary of the Treasury the amounts so determined. The Secretary
  shall thereupon, and prior to audit or settlement by the General Accounting
  Office, pay to the State the amounts so certified.
  (f) Funds paid to a State for any class of personal health-service benefits
  shall be used exclusively for the provision of benefits of that class,
  except that the administrative costs of the State in administering personal
  health-service benefits under this Act may be met from the allotments to
  the State. Such administrative costs, which in any fiscal year shall not
  exceed 5 percent of the aggregate allotments to the State for such fiscal
  year, shall be apportioned as between the several allotments in accordance
  with the costs of administering the respective classes of benefits;
  and such apportionment may be made in such manner, and by such sampling,
  statistical, or other methods, as may be agreed upon between the Board
  and the State agency.
  (g) In any case in which the Board has assumed responsibility for the
  administration in a State of benefits under this Act in accordance with
  section 402 (d) or (e), all allotments or balances of allotments to such
  State shall be available for expenditure by the Board for the provision of
  personal health-service benefits in that State, and (until the Congress
  shall make funds available therefor pursuant to section 801(a)) for the
  costs of administration of such benefits in such State. Expenditures
  authorized pursuant to section 801(a) for such costs of administration
  shall be charged against allotments to such State.
grants-in-aid for training and education
  SEC. 803. (a) For the purpose of increasing the availability of training and
  education for professional and technical personnel engaged or undertaking
  to engage in the provision or administration of personal health services as
  benefits under this Act, and to carry out the policies of section 209(a),
  the Board is authorized to make grants--
  (1) to public or nonprofit institutions or agencies engaging in undergraduate
  or postgraduate professional, technical, or administration education
  or training, for the cost (in whole or in part) of courses or projects
  which the Board finds, after consultation with the Advisory Council and
  appropriate Federal departments and agencies, (A) cannot be carried out
  without financial assistance under this section, and (B) show promise of
  making valuable contributions to the education, training, or retraining
  of professional or technical personnel engaged or undertaking to engage
  in the provision or administration of benefits, or
  (2) to individuals who are professional or technical persons engaged or who
  undertake to engage in the provision of personal health-service benefits,
  or who are engaged or undertake to engage in the administration of such
  benefits, for maintenance (in whole or in part) while in attendance at
  courses or projects assisted under paragraph (1) or approved by the Board
  for similar training or education, and for costs of necessary travel.
  (b) Such grants, in such amounts and for payment at such times as are
  approved by the Board, shall be certified for payment to the Secretary
  of the Treasury, who shall pay them from the account to the designated
  individuals, institutions, or agencies.
  (c) For the purposes of this section there shall be available for the fiscal
  year 1990 the sum of $50,000, for the fiscal year 1990 the sum of $50,000,
  and for each fiscal year thereafter an amount not to exceed one-half of
  1 percent of the amount expended for benefits under this Act in the last
  preceding calendar year.
TITLE IX-- MISCELLANEOUS PROVISIONS
definition
  SEC. 901. As used in this Act:
  (1) The term `wages' means the sum of the following items, excluding
  any amount in excess of the applicable contribution and benefit base (as
  determined under section 230 of the Social Security Act) which is received
  (or, in the case of income from self-employment, accrued) by any individual
  during any calendar year--
  (A) all remuneration for employment, including the cash value of all
  remuneration paid in any medium other than cash; except that such term
  does not include--
  (i) the amount of any payment made to, or on behalf of, an employee under
  a plan or system established by an employer which makes provision for his
  employees generally or for a class or classes of his employees (including
  any amount paid by an employer for insurance or annuities, or into a fund
  to provide for any such payment), on account of retirement, or sickness or
  accident disability, or medical and hospitalization expenses in connection
  with sickness or accident disability, or death; provided, in the case
  of a death benefit, that the employee (I) has not the option to receive,
  instead of provision for such death benefit, any part of such payment or,
  if such death benefit is insured, any part of the premiums (or contributions
  to premiums) paid by his employer, and (II) has not the right, under the
  provisions of the plan or system or policy of insuracne providing for such
  death benefit, to assign such benefit, or to receive a cash consideration
  in lieu of such benefit either upon his withdrawal from the plan or system
  providing for such benefit or upon termination of such plan or system or
  policy of insurance or of his employment with such employer;
  (ii) the payment by an employer (without deductions from the remuneration
  of the employee) of any social-insurance taxes or contributions imposed
  upon an employee; or
  (iii) the value of services exchanged for other services for which there
  is no payment other than the exchange; and
  (B) all net income from farm, business, professional, or other
  self-employment.
  (2) The term `employment' means any service of whatever nature performed by
  an employee for the person employing him, irrespective of the citizenship or
  residence of either, within United States, or on or in connection with an
  American vessel or an American civil aircraft under a contract of service
  which is entered into within the United States or during the performance
  of which the vessel or aircraft touches at a port or airport in the United
  States, if the employee is employed on and in connection with such vessel
  or aircraft when outside the United States, except--
  (A) service on active duty in the Armed Forces of the United States;
  (B) service performed in the employ of a State or any political subdivision
  thereof, or any instrumentality of any one or more of the foregoing which
  is wholly owned by one or more States or political subdivisions;
  (C) casual labor not in the course of the employer's trade or business;
  (D) service performed by an employee on or in connection with a vessel
  not an American vessel, or an aircraft not an American aircraft, if the
  employee is employed on and in connection with such vessel or aircraft
  when outside the United States;
  (E) service performed by a duly ordained or duty commissioned or licensed
  minister of any church in the regular exercise of his ministry and service
  performed by a regular member of a religious order in the exercise of
  duties required by such order;
  (F) service performed by an individual as an employee or employee
  representative as defined in section 1 of the Railroad Retirement Act of
  1937 or section 1 of the Railroad Retirement Act of 1974;
  (G) service performance in any calendar quarter in the employ of any
  organization exempt from income tax under section 501 of the Internal
  Revenue Code of 1986 if--
  (i) the remuneration for such services does not exceed $45; or
  (ii) such service is in connection with the collection of dues or premiums
  for a fraternal beneficiary society, order, or association, and is performed
  away from the home office or is ritualistic service in connection with
  any such society, order, or association; or
  (iii) such service is performed by a student who is enrolled and is
  regularly attending classes at a school, college, or university;
  (H) service performed in the employ of a foreign government (including
  service as a consular or other officer or employee or a nondiplomatic
  representative);
  (I) service performed in the employ of an instrumentality wholly owned by
  a foreign government, if--
  (i) the service is of a character similar to that performed in foreign
  countries by employees of the United States Government or of an
  instrumentality thereof; and
  (ii) the Secretary of State shall certify to the Secretary of Health
  and Human Services that the foreign government, with respect to whose
  instrumentality and employees thereof exemption is claimed, grants an
  equivalent exemption with respect to similar service performed in the
  foreign country by employees of the United States Government and of
  instrumentalities thereof; and
  (J) service performed in the employ of an international organization
  entitled to enjoy privileges, exemptions, and immunities as an international
  organization under the International Organizations Immunities Act.
  (3) In any case in which an individual has received wages equal to the
  applicable contribution and benefit base (as determined under section 230
  of the Social Security Act), in a calendar year, not less than $150 of such
  wages shall be deemed, for the purpose of section 104(a), to have been
  received by him in the quarter during which the first of such wages were
  in fact received by him and in each quarter of such calendar year thereafter.
  (4) The term `benefit year' means a period commencing on July 1 of any
  year and ending on June 30 of the succeeding year.
  (5) The term `quarter' and the term `calendar quarter' mean a period of three
  calendar months ending on March 31, June 30, September 30, or December 31.
  (6) The term `employee' includes (in addition to any individual who is a
  servant under the law of master and servant) any individual who performs
  service, of whatever nature, for a person, unless the service is performed by
  the individual in pursuit of his own independently established business. The
  term `employee' also includes an officer of a corporation.
  (7) The term `American vessel' means any vessel documented or numbered
  under the laws of the United States; and includes any vessel which is
  neither documented nor numbered under the laws of any foreign country,
  if its crew is employed solely by one or more citizens or residents of
  the United States or corporations organized under the laws of the United
  States or of any State.
  (8) The term `American aircraft' means an aircraft registered under the
  laws of the United States.
  (9) The term `State' includes the District of Columbia.
  (10) The term `United States', when used in a geographic sense, means the
  several States, as defined in paragraph (9).
  (11) The term `dependent' means an unmarried child (including a stepchild,
  adopted, or foster child) of an individual, who is under the age of eighteen,
  or who is under a total disability which has continued for a period of not
  less than six consecutive calendar months and is living with such individual
  or receiving regular support from him; a wife of an individual living with
  such individual or receiving regular support from him; a husband who is
  under a total disability which has continued for a period of not less than
  six consecutive calendar months, and is living with or receiving regular
  and substantial support from such individual; and a parent who is living
  with or receiving regular and substantial support from such individual.
  (12) The term `person' means an individual, a trust or estate, a partnership,
  a corporation, an association, a consumer cooperative, or other organization.
effective date
  SEC. 902. The effective date of this Act shall be the date of its enactment,
  but personal health services shall first become available as benefits in
  accordance with this Act on October 1, 1990.